ATBC Study analyses

by Harri Hemila

Department of Public Health
University of Helsinki, Finland
harri.hemila@helsinki.fi
http://www.mv.helsinki.fi/home/hemila
Aug 6
, 2020

For a background for the ATBC Study, see:
https://atbcstudy.cancer.gov/

http://dx.doi.org/10.1056/NEJM199404143301501
http://dx.doi.org/10.1093/jnci/88.21.1560

Analysis of the ATBC Study in Thesis (2006):
https://helda.helsinki.fi/handle/10138/20335




  1. Pneumonia

  2. Tuberculosis

  3. The common cold

  4. Mortality



Pneumonia

Hemilä H
7. Effect of β-Carotene Supplementation on the Risk of Pneumonia Is Heterogeneous in Males: Effect Modification by Cigarette Smoking
J Nutr Sci Vitaminol (Tokyo) 2018
https://doi.org/10.3177/jnsv.64.374

About 89% of the variation in the effect of vitamin E supplementation on pneumonia risk for five subgroups of the ATBC population was true variation in vitamin E effect instead of chance variation.
Hemila H.
6.Vitamin E and the risk of pneumonia: using the I2-statistic to quantify heterogeneity within a controlled trial.
Br J Nutrition 2016
https://doi.org/10.1017/S0007114516003408

Vitamin E may decrease the incidence of pneumonia in elderly males by 72% if they are not smoking
Hemila H.
5.Vitamin E administration may decrease the incidence of pneumonia in elderly males.
Clinical Interventions in Aging 2016
https://dx.doi.org/10.2147/CIA.S114515
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055121

Very strong evidence that vitamin E effect on pneumonia incidence is modified by smoking and level of exercise (P = 0.0004)
Vitamin E increased risk in some people, decreased risk in some other people, and had no effect in the majority
.
Hemila H, Kaprio J.
4.Subgroup analysis of large trials can guide further research: a case study of vitamin E and pneumonia.
Clin Epidemiol 2011
http://dx.doi.org/10.2147/CLEP.S16114
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046185
Prepublication history:
http://www.mv.helsinki.fi/home/hemila/PPH/CE/CE.html

Different approach compared with that above.
Restriction to males who started smoking at early age: pneumonia risk was increased 14% by vitamin E.
The increase in risk was restricted to low weight participants (+61%) and high weight participants (+134%).
Hemila H, Kaprio J.
3.Vitamin E supplementation and pneumonia risk in males who initiated smoking at an early age: effect modification by body weight and vitamin C.
Nutr J 2008
http://dx.doi.org/10.1186/1475-2891-7-33
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2603040

Vitamin E halved the incidence of pneumonia in Finnish males who carried out leisure time exercise.
Hemila H, Kaprio J, Albanes D, Virtamo J.
2.Physical activity and pneumonia in male smokers administered vitamin E and β-carotene.
Int J Sports Med 2006
http://dx.doi.org/10.1055/s-2005-865670
http://hdl.handle.net/10138/18749   
Links to references are added

Vitamin E effect on the incidence of pneumonia was significantly modified by smoking
Hemila H, Virtamo J, Albanes D, Kaprio J.
1.Vitamin E and beta-carotene supplementation and hospital-treated pneumonia incidence in male smokers.
Chest 2004
http://dx.doi.org/10.1378/chest.125.2.557


Tuberculosis

Vitamin E increased TB risk by 125% in people who had high dietary intake of vitamin C and smoked heavily
Hemila H, Kaprio J.
2.Vitamin E supplementation may transiently increase tuberculosis risk in males who smoke heavily and have high dietary vitamin C intake.
Br J Nutr 2008 [Discussion: 2009;101:145-147]
http://dx.doi.org/10.1017/S0007114508923709
   
Comments:
    http://dx.doi.org/10.1017/S0007114508994411
   
Reply:
    http://dx.doi.org/10.1017/S0007114508994423

Hemila H, Kaprio J, Pietinen P, Albanes D, Heinonen OP.
1.Vitamin C and other compounds in vitamin C rich food in relation to risk of tuberculosis in male smokers.
Am J Epidemiology 1999
http://dx.doi.org/10.1093/oxfordjournals.aje.a010062

The Common Cold

Hemilä H
4.The effect of β-carotene on common cold incidence is modified by age and smoking: evidence against a uniform effect in a nutrient-disease relationship.
Nutrition and Dietary Supplements 2010
http://dx.doi.org/10.2147/NDS.S13299
http://www.dovepress.com/article_5490.t2368605

Very strong evidence that the effect of vitamin E on the risk of common cold depends on age.
Vitamin E increased or decreased common cold risk in men older than 65 years
Hemila H, Virtamo J, Albanes D, Kaprio J.
3.The effect of vitamin E on common cold incidence is modified by age, smoking and residential neighborhood.
J Am Coll Nutr 2006
http://dx.doi.org/10.1080/07315724.2006.10719543
https://helda.helsinki.fi/handle/10138/228095

Vitamin E had no substantial effect on common cold risk in males with heavy job or with heavy leisure time exercises.
Hemila H, Virtamo J, Albanes D, Kaprio J.
2.Physical activity and the common cold in men administered vitamin E and β-carotene.
MSSE 2003
http://hdl.handle.net/10138/18380  Links to references are added
http://dx.doi.org/10.1249/01.MSS.0000093616.60899.92

Dietary vitamin E intake did not correlate with the common cold incidence
Hemila H, Kaprio J, Albanes D, Heinonen OP, Virtamo J.
1.Vitamin C, vitamin E and beta-carotene in relation to common cold incidence in male smokers.
Epidemiology 2002
http://hdl.handle.net/10138/18059  Links to references are added
http://dx.doi.org/10.1097/00001648-200201000-00006
http://www.jstor.org/pss/3703244

Mortality

Further evidence of heterogeneity in the effects of vitamin E on mortality
Hemilä H.
6. Vitamin E and Mortality in Male Smokers of the ATBC Study: Implications for Nutritional Recommendations.
Frontiers in Nutrition 2020
https://doi.org/10.3389/fnut.2020.00036
http://www.ncbi.nlm.nih.gov/pmc/articles/pmc7136753


Hemilä H
5.The effect of β-carotene on the mortality of male smokers is modified by smoking and by vitamins C and E: evidence against a uniform effect of nutrient
J Nutr Sci 2020
https://doi.org/10.1017/jns.2020.3
http://www.ncbi.nlm.nih.gov/pmc/articles/pmc7082716

Hemilä H
4.Comparison of different vitamin E forms is confounded by heterogeneity in vitamin E effects.
Nutrition Reviews 2018
https://doi.org/10.1093/nutrit/nuy038

In Finnish male smokers, vitamin E extended life span by half a year
Hemila H, Kaprio J.
3.Vitamin E may affect the life expectancy of men, depending on dietary vitamin C intake and smoking.
Age Ageing 2011
http://dx.doi.org/10.1093/ageing/afq178
Prepublication history:
http://www.mv.helsinki.fi/home/hemila/PPH/AA/AA.html


Hemilä H.
2.Vitamin E is likely to affect mortality even at low doses.
Clinical Trials 2009
http://dx.doi.org/10.1177/1740774509340211
https://helda.helsinki.fi/handle/10138/16982
http://www.mv.helsinki.fi/home/hemila/H/2009_L_ClinTrials_2p.pdf 

Very strong evidence that vitamin E effect on mortality is modified by age and dietary vitamin C intake (P = 0.0005)
Hemila H, Kaprio J.
1.Modification of the effect of vitamin E supplementation on the mortality of male smokers by age and dietary vitamin C.
Am J Epidemiol 2009
http://dx.doi.org/10.1093/aje/kwn413
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661323